title: The high volume debate in a low volume country: centralisation of oesophageal resection in New Zealand.
abstract: OBJECTIVE
  Centralisation of oesophageal resection for cancer remains an area of debate. However, no consensus for the requirements of high volume centres yet exists and some low volume centres have been able to produce a comparable outcome. With the small population of New Zealand more than one high volume centre might not be achievable. We reviewed our series of oesophageal resections and compared them to outcomes in the literature to challenge the need for only high volume centres within New Zealand
  
  
  METHODS
  A retrospective analysis of all consecutive oesophagogastrectomies performed in Christchurch Public Hospital (Christchurch City, New Zealand) from January 1998 until June 2009 was undertaken.
  
  
  RESULTS
  Within this period 128 oesophagogastrectomies were performed. Median admission duration was 12 days. The overall complication rate was 53.9% of which 5.5% was an anastomotic leak. Combined in-hospital and 30-day-mortality was 1.6% (2/128). The 5-year-survival was 32.4% for adenocarcinoma and 47.7% for squamous cell carcinoma. Conclusion This series has shown that a low volume centre within New Zealand is able to deliver a satisfactory level of care for oesophagectomy. Given New Zealand's low population density it is debatable to what extent care should be centralised for treatment of oesophageal carcinoma.
authors.affiliation: Department of Surgery, Christchurch Hospital, PO Box 4345, Christchurch, New Zealand.
authors.forename: Edwin
authors.initials: E
authors.lastname: Beenen
authors.forename: Welson
authors.initials: W
authors.lastname: Jao
authors.forename: Grant
authors.initials: G
authors.lastname: Coulter
authors.forename: Ross
authors.initials: R
authors.lastname: Roberts
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D018365:Neoplasm, Residual; D009520:New Zealand; D010359:Patient Readmission; D012189:Retrospective Studies; D015996:Survival Rate